Pain Assessment in Cattle by Use of Numerical Rating and Visual Analogue Scales-A Systematic Review and Meta-Analysis.

Subjective pain assessment in cattle is contingent upon the observer's experience and attitude. Studies of pain assessment in cattle by veterinarians and farmers using different pain scales have been published. This systematic review and meta-analysis aimed to describe and compare the pain scores given by veterinarians and producers for different procedures and conditions using either a NRS or VAS. The literature search was conducted with PubMed (MEDLINE) and Agricola, using defined search terms (e.g., peer-reviewed). A total of 842 articles were identified. After screening of duplicates, abstracts, and full texts, a total of 16 articles were included in this systematic review. Different pain scales were used for the included studies (NRS 0-10 for eight studies, NRS 1-10 for six studies, NRS 1-10 and VAS 0-10 for one study, and VAS 0-1 for one study). Most studies (n = 11) originated from the European Union. Mean values for pain scores differed significantly between studies included in the meta-analysis for both NRS 0-10 and 1-10. The findings of this study indicated that comparison of pain scoring used in different studies is difficult due to use of different pain scales and varying nomenclature, and that many variables (such as age and gender) influence pain scoring.

Preoperative and postoperative diagnostic efficiency of multi-inflammatory index on pain scoring of degenerated intervertebral disc.

BACKGROUND: The inflammatory index can be useful for neurosurgeons to understand and grade pain in degenerated intervertebral disc (DIVD). OBJECTIVES: The study focused on the value of the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and the inflammatory multiple indices (MIs), and aimed to compare its efficiency with the preoperative and postoperative pain scale and scoring algorithms. MATERIAL AND METHODS: A total of 88 DIVD patients were included in this retrospective clinical cohort study. Visual Analogue Scale Back (VASB) and Visual Analogue Scale Leg (VASL), Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and walking distance (WD) were used to assess pain. The multiple index (MI) was calculated as MI-1 = PLR × C-reactive protein (CRP) and MI-2 = NLR × CRP. RESULTS: Comparing the MI with ODI, no correlation was found in preoperative values, while a positive correlation (MI-1: r = 0.398, p < 0.001; MI-2: r = 0.285; p = 0.007) was found between the postoperative measurements. A significant correlation was found for VASB and both MI-1 (preoperative: r = 0.373, p = 0.001; postoperative: r = 0.232, p = 0.041) and MI-2 (preoperative: r = 0.388, p < 0.001; postoperative: r = 0.206, p = 0.044). The MI-1 index showed 71.4% sensitivity and 73.3% specificity, while the MI-2 index exhibited 78.6% sensitivity and 68.9% specificity. CONCLUSIONS: MI-1 and MI-2 showed a positive correlation with preand post-operative VASB score and had strong potential to predict postoperative pain in DIVD. They are easy-to-use, noninvasive and low-cost indices; therefore, our results are promising for routine application.

Influence of Butorphanol, Buprenorphine and Levomethadone on Sedation Quality and Postoperative Analgesia in Horses Undergoing Cheek Tooth Extraction.

The aim of this prospective clinical trial was to compare the influence of butorphanol, buprenorphine and levomethadone on sedation quality and postoperative analgesia in horses undergoing cheek tooth extraction. Fifty horses were assigned to three groups prior to oral cheek tooth extraction. Horses were treated with acepromazine, followed by a detomidine bolus, one of the three opioids and both a nerve block and gingival anaesthesia. During the surgery, sedation was maintained with a detomidine constant rate infusion. After surgery, the quality of sedation, surgical conditions and severity of the extraction were assessed with a numerical rating scale. To evaluate differences in the quality of analgesia between the three treatments, postoperative pain was estimated with the Equine Utrecht University Scale for Facial Assessment of Pain. Additionally, several parameters that are associated with dental pain were added to this validated pain score, and blood samples were taken to measure serum cortisol. Our analysis showed lower pain scores and a greater analgesic effect with levomethadone and buprenorphine compared with butorphanol, with increased locomotor activity induced by buprenorphine. While cortisol values demonstrated higher response in horses treated with levomethadone and buprenorphine compared to butorphanol, these values could be biased by unrelated stressors.

Implementation of an Automated Text Message-Based System for Tracking Patient-Reported Outcomes in Spine Surgery: An Overview of the Concept and Our Early Experience.

OBJECTIVE: Text message-based interventions have been demonstrated to be a valuable monitoring tool across various conditions. Here, we aimed to describe our early experience using a newly developed text message-based platform designed to track symptoms in spine surgery patients. METHODS: We used the Informed Mindset Medical (IMM) platform to automatically send text messages with secure and encrypted hyperlinks to enrolled patients. Patient symptoms were monitored using well-standardized functional assessments. Limited patient data and responses were stored on a Health Insurance Portability and Accountability Act-compliant SQL cloud-based server database. RESULTS: In 3 months, 101 patients scheduled for elective spine surgery accepted participation in our pilot study. Overall, 71.2% of the enrolled patients responded to at least 1 preoperative baseline questionnaire. The response rates were similar across attendings, questionnaire bundles (cervical vs. thoracolumbar), genders, and age groups. The overall preoperative IMM pain scores were found to correlate positively with the preoperative electronic medical record pain rates. Similarly, the overall preoperative IMM and electronic medical record pain scores correlated positively with the IMM-collected Neck Disability Index/Oswestry Disability Index scores. From an initial 71.2%, the response rate decreased to 54.9% for the 6-week follow-up questionnaires. CONCLUSIONS: Our preliminary findings support the reliability of this text message-based strategy to monitor symptoms in spine surgery patients. Further studies are warranted to explore strategies to increase the response rate and expand this platform's clinical and research applicability.

Manejo del dolor óseo en pacientes cancerosos / Bony pain management in cancerous patients

Las metástasis óseas se desarrollan en aproximadamente 30 a 70% de todos los pacientes con cáncer. El dolor es una experiencia de la condición humana universal, y es común que las personas busquen atención médica a raíz de ello. El presente estudio tuvo como objetivo describir la eficacia y el papel de diferentes estrategias en el control del dolor óseo en pacientes cancerosos metastásicos. Se trata de un estudio observacional realizado entre el 1 de diciembre de 2018 y el 30 de diciembre de 2019. Se inscribieron exactamente 100 pacientes cancerosos. Los pacientes fueron evaluados antes de recibir las modalidades de control del dolor, al principio y al final del tratamiento. La puntuación del dolor óseo se utilizó de 0 (sin dolor) a 10 (el peor dolor). Nuestros hallazgos con respecto al sexo, hubo 51 (51%) hombres y 49 (49%) mujeres. La edad media fue de 57,3 ± 11,2 años y el grupo de edad más frecuente fue de 41-50 años, 37 (37%). Entre los tipos de cáncer, el cáncer de mama ocupa el primer lugar entre los casos estudiados en nuestra investigación 37 (37%), seguido del cáncer de próstata 24 (24%). Las vértebras de la columna fueron el sitio más representado en un 52%, seguido de los huesos pélvicos en un 36%. La mayoría de los pacientes no requirieron cirugía. Mientras que el 15% de los pacientes se sometieron a descompresión del cordón, el 13% requirió fijación interna y solo cuatro pa- LA PRENSA MÉDICA ARGENTINA Bony pain management in cancerous patients 117 V.107/Nº 2 cientes se sometieron a vertebroplastia. El dolor agudo se describió comúnmente en un 40%, seguido de naturaleza punzante en un 15%. El dolor frecuente fue más prevalente en el 60% de los pacientes, mientras que el dolor constante se presentó en el 40%. La noche fue el momento más común de sentir dolor en el 55%. Después de recibir el tratamiento, varias modalidades provocan un desplazamiento de la puntuación del dolor hacia abajo. Combinación de más de estrategias más eficientes que utilizar una opción para el manejo del dolor óseo con un mejor resultado y pronóstico.

Bone metastases develop in approximately 30­70% of all cancer patients. Pain is a universal human experience condition, and it is a common question for people to seek health care. The study aimed to describe the efficacy and roles of different strategies in the control of bony pain in metastatic cancerous patients. This is an observational study carried out, from the 1st of December 2018 to the 30th of December 2019. Exactly 100 cancerous patients were enrolled. Patients were assessed before received of pain control modalities, in the beginning, and at the end of treatment. Bone pain scoring was used from 0 (no pain) to 10 (the worst pain). Our findings regarding sex, there were 51(51%) male and 49(49%) female. The mean age was 57.3±11.2 years, and the most frequent age group was 41-50 years as 37(37%). Among cancer types, breast cancer comes in 1st rank cases studied in our research 37(37%), followed by prostate cancer 24(24%). Spine vertebrae were the most site figured 52%, followed by pelvic bones in 36%. Most patients did not require surgery. Whereas 15% of patients underwent cord decompression, 13% required internal fixation and only four patients performed for vertebroplasty. The sharp pain was commonly described by 40%, followed by stabbing nature in 15%. Frequent pain was more prevalent in 60% of patients, whereas constant pain presented in 40%. The night was the commonest timing of feeling pain in 55%. After receiving treatment, several modalities cause shifting of the pain scoring downward. Combination of more than strategies more efficient than of use one option for manage of bone pain with a better outcome, and prognosis.

Can Endocrine Dysfunction Be Reliably Tested in Aged Horses That Are Experiencing Pain?

The aim of the present study was to evaluate (i) the effects of different intensities and types of treated pain on the basal concentrations of adrenocorticotropic hormone (ACTH) and cortisol, and (ii) the thyrotropin-releasing hormone (TRH) stimulation test, to determine whether treated pain caused a marked increase of ACTH, which would lead to a false positive result in the diagnosis of pituitary pars intermedia dysfunction (PPID). Methods: Fifteen horses with treated low to moderate pain intensities were part of the study. They served as their own controls as soon as they were pain-free again. The horses were divided into three disease groups, depending on their underlying disease (disease group 1 = colic, disease group 2 = laminitis, disease group 3 = orthopedic problems). A composite pain scale was used to evaluate the intensity of the pain. This pain scale contained a general part and specific criteria for every disease. Subsequently, ACTH and cortisol were measured before and after the intravenous application of 1 mg of TRH. Results: There was no significant difference in the basal or stimulated ACTH concentration in horses with pain and controls, between different pain intensities or between disease groups. Descriptive statistics, however, revealed that pain might decrease the effect of TRH on the secretion of ACTH. There was an increase of ACTH 30 min after TRH application (p = 0.007) in the treated pain group, but this difference could not be statistically confirmed. Measuring the basal ACTH concentration and performing the TRH stimulation test for the diagnosis of PPID seem to be possible in horses with low to moderate pain.

Clinical applicability of the Feline Grimace Scale: real-time versus image scoring and the influence of sedation and surgery.

BACKGROUND: The Feline Grimace Scale (FGS) is a facial expression-based scoring system for acute pain assessment in cats with reported validity using image assessment. The aims of this study were to investigate the clinical applicability of the FGS in real-time when compared with image assessment, and to evaluate the influence of sedation and surgery on FGS scores in cats. METHODS: Sixty-five female cats (age: 1.37 ± 0.9 years and body weight: 2.85 ± 0.76 kg) were included in a prospective, randomized, clinical trial. Cats were sedated with intramuscular acepromazine and buprenorphine. Following induction with propofol, anesthesia was maintained with isoflurane and cats underwent ovariohysterectomy (OVH). Pain was evaluated at baseline, 15 min after sedation, and at 0.5, 1, 2, 3, 4, 6, 8, 12 and 24 h after extubation using the FGS in real-time (FGS-RT). Cats were video-recorded simultaneously at baseline, 15 min after sedation, and at 2, 6, 12, and 24 h after extubation for subsequent image assessment (FGS-IMG), which was performed six months later by the same observer. The agreement between FGS-RT and FGS-IMG scores was calculated using the Bland & Altman method for repeated measures. The effects of sedation (baseline versus 15 min) and OVH (baseline versus 24 h) were assessed using linear mixed models. Responsiveness to the administration of rescue analgesia (FGS scores before versus one hour after) was assessed using paired t-tests. RESULTS: Minimal bias (-0.057) and narrow limits of agreement (-0.351 to 0.237) were observed between the FGS-IMG and FGS-RT. Scores at baseline (FGS-RT: 0.16 ± 0.13 and FGS-IMG: 0.14 ± 0.13) were not different after sedation (FGS-RT: 0.2 ± 0.15, p = 0.39 and FGS-IMG: 0.16 ± 0.15, p = 0.99) nor at 24 h after extubation (FGS-RT: 0.16 ± 0.12, p = 0.99 and FGS-IMG: 0.12 ± 0.12, p = 0.96). Thirteen cats required rescue analgesia; their FGS scores were lower one hour after analgesic administration (FGS-RT: 0.21 ± 0.18 and FGS-IMG: 0.18 ± 0.17) than before (FGS-RT: 0.47 ± 0.24, p = 0.0005 and FGS-IMG: 0.45 ± 0.19, p = 0.015). CONCLUSIONS: Real-time assessment slightly overestimates image scoring; however, with minimal clinical impact. Sedation with acepromazine-buprenorphine and ovariohysterectomy using a balanced anesthetic protocol did not influence the FGS scores. Responsiveness to analgesic administration was observed with both the FGS-RT and FGS-IMG.

Development of a Pain Scoring System for Use in Sheep Surgically Implanted with Ventricular Assist Devices.

Purpose/Aim: In prey species, such as sheep, clinical signs of postoperative pain can manifest in subtle ways or may be concealed entirely. Previous publications describing pain assessment in ruminants focus on lameness and flock behavior, often in a farm environment. These indicators of pain may be difficult to assess in sheep housed in biomedical research settings. We have developed a novel pain scoring system for sheep undergoing thoracotomy for implantation of ventricular assist devices that are permanently housed in modified stanchions. Materials and Methods: The pain scoring system includes ruminant-specific behavioral signs of pain in addition to objective measurements that can be readily evaluated in a biomedical research setting. A numerical score is generated by the evaluator for each category. A decision tree is utilized to help guide further action following the generation of a cumulative score by the evaluator. A total score of 0-2 requires no intervention, 3-9 requires the consideration of additional analgesic administration, and a pain score ≥ 10 warrants the consideration of additional multimodal analgesia. Results: A novel pain scoring system and decision tree specifically designed for sheep undergoing thoracotomy in a biomedical research environment was developed and successfully utilized. Out of 102 postoperative pain scores measured, 86 scores were <2. There were 17/102 postoperative pain scores ≥3, which typically resulted in the administration of supplemental rescue analgesia in the immediate postoperative period. Conclusions: A novel pain scoring system was developed and utilized in a biomedical research environment for evaluating postoperative pain in sheep undergoing thoracotomy for implantation of a ventricular assist device. Further studies are necessary to validate the reliability of this novel pain scoring system.

Acute pain in cats: Recent advances in clinical assessment.

PRACTICAL RELEVANCE: Pain assessment has gained much attention in recent years as a means of improving pain management and treatment standards. It has become an elemental part of feline practice with ultimate benefit to feline health and welfare. Currently pain assessment involves mostly the investigation of sensory-discriminative (intensity, location and duration) and affective-motivational (emotional) domains of pain. Specific behaviors associated with acute pain have been identified and constitute the basis for its assessment in cats. RECENT ADVANCES: The publication of pain scales with reported validation - the UNESP-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale - and species-specific studies have advanced our knowledge on the subject. Facial expressions have also been shown to be different between painful and non-painful cats, and very recently the Feline Grimace Scale has been validated as a tool for acute pain assessment. CLINICAL CHALLENGES: Despite recent advances, several challenges still exist. For instance, the effects of disease and sedation on pain scoring/ assessment are unknown. Also, specific painful conditions (eg, dental pain) have not been systematically investigated. The development and validation of instruments for pain assessment by cat owners is warranted, as these tools are currently lacking. AIMS: This article reviews the use, advantages, disadvantages and limitations of the two validated pain scales, and presents a practical, stepwise approach to feline pain recognition and assessment using a dynamic and interactive process. The authors also offer perspectives regarding current challenges and future directions.

Validation of the Italian version of the UNESP-Botucatu unidimensional composite pain scale for the assessment of postoperative pain in cattle.

OBJECTIVE: The aim of this study was to validate the Italian version of the UNESP-Botucatu Unidimensional Composite Pain Scale (UCPS-IV) for assessing postoperative pain in cattle. STUDY DESIGN: Video analysis and psychometric testing. ANIMALS: A total of 40 Nellore cattle, age 2-3 years, weighing 365±51 kg. METHODS: An English version of the scale was translated to Italian and back translated to English to ensure semantic equivalence. A total of four Italian observers and the researcher who developed the original scale (considered as the gold standard) analysed videos of 40 cattle previously subjected to orchiectomy (recorded for each cattle at four predetermined timepoints during the perioperative period) unaware of the videos' timepoint. They assigned a pain score [ranging from no pain (0) to severe pain (10)] using the Italian version of the scale and verified the need for analgesic treatment for each animal. The obtained scores were subjected to psychometric validity, responsiveness and reliability tests. RESULTS: The factor analysis of the scale resulted in a one-factor solution. Significant changes in pain scores in response to surgery and analgesics confirmed not only the content and construct validity, but also responsiveness. The agreement between the researcher who developed the original scale and the blinded observers and the correlation between the pain scores determined by the scale and those determined by three classical unidimensional pain scales confirmed criterion and concurrent validity. Internal consistency of the scale was excellent. Inter- and intrarater reliability ranged from moderate to good and from moderate to very good for all scale items, respectively, supporting reproducibility and stability. The cut-off point for rescue analgesia calculated by the receiver operating characteristic curve was > 3. CONCLUSIONS AND CLINICAL RELEVANCE: The results confirm that the UNESP-Botucatu UCPS-IV appears to be a valid and reliable tool for the assessment of postorchiectomy pain in the bovine species. The determination of a cut-off point for rescue analgesia is also helpful for guiding analgesic therapy.

Comparative Therapeutic Efficacy of 153Sm-EDTMP and 177Lu-EDTMP for Bone Pain Palliation in Patients with Skeletal Metastases: Patients' Pain Score Analysis and Personalized Dosimetry.

INTRODUCTION: The aim of the present study was to compare the therapeutic efficacy of 153Sm-EDTMP and 177Lu-EDTMP in pain palliation in cancer patients with skeletal metastases. MATERIALS AND METHODS: Thirty patients (25 M:5 F, mean age: 66.0 ± 14.7 years) of breast/prostate cancer with documented skeletal metastases were recruited prospectively. Twenty patients were considered randomly for treatment with 153Sm-EDTMP and with 177Lu-EDTMP in 10 patients, respectively. Using fixed dose of 37.0 MBq/kg body weight of each, the mean administered doses of 153Sm-EDTMP and 177Lu-EDTMP were 2,155.2 ± 419.6 MBq (1,347-2,857) and 1,935.1 ± 559.4 MBq (1,073-2,627), respectively. Anterior and posterior whole body images were acquired at different time points following radioactivity administration. The first data set of pre-void images (acquired at 0.5 h) representing the total activity of either of 153Sm-EDTMP or 177Lu-EDTMP was considered as reference images. All the serial images were used for patients' dosimetry analysis by using organ level internal dosimetry assessment algorithm. Reduction in pain scoring was assessed clinically over 8 weeks by using appropriate WHO criteria and correlated with the absorbed dose to the metastatic sites. RESULTS: A total of 86 metastatic lesions clearly visualized on post-therapy serial images (matching on bone scans) were evaluated for absorbed dose calculations. Both 153Sm-EDTMP and 177Lu-EDTMP delivered similar absorbed dose to the metastatic sites, i.e., 6.22 ± 4.21 and 6.92 ± 3.92 mSv/MBq, respectively. The mean absorbed doses to various other organs were found to be comparable and within the safe limits. A complete response (CR) for each radionuclide was evaluated as 80.0%. No significant alternation in blood parameters and no untoward reaction were observed. However, a mild to severe toxicity was observed in two patients (1 each with 153Sm-EDTMP and 177Lu-EDTMP). Kaplan-Meier survival analysis demonstrated that 27/30 patients had pain-free survival (CR) up to the observational period of 8 weeks. However, no statistically significant correlation could be established between the pain scoring and absorbed dose to metastatic sites. CONCLUSION: Both the radionuclides thus offer an effective and comparable therapeutic efficacy for bone pain palliation at an affordable cost and can be used interchangeably as per the availability.

Validation of a system to evaluate chronic functional joint instability rehabilitation therapy / 解剖学报

Objective: To investigate the assessment of patients with functional ankle instability prior to and post of regular rehabilitation therapies. Methods: One hundred and twenty-four patients with unilateral chronic ankle instability (51 females and 73 males, age 34-56) were received conventional rehabilitation for two month, including muscle strength, range of joint motion, balance, proprioception, etc. The visual analogue scale (V AS) scores (instant pain and pain after 500-meter walk) were recorded. Standing time of affected limb, the star excursion balance test, static and dynamic plantar pressure were performed. Results: There were significant differences in VAS pain score of instant pain (5. 32 ±0.27 vs 1. 07 ± 0. 08) and after 500 meter walk (8. 79 ± 1. 78 vs 4. 51 ± 1. 78) (P 0. 05). Conclusion: Rehabilitation therapy can significantly improve the pain-release, the balance, etc. However, the effect on the dynamic response is not accurate. Thus, the abnormal of walking posture, the biomechanics of the foot and ankle, and biomechanics of functional ankle instability should be considered during the rehabilitation treatment.

The advantages of carbon dioxide laser applications in paediatric oral surgery. A prospective cohort study.

The aim of this study is to evaluate and demonstrate the advantages of the carbon dioxide laser in paediatric oral surgery patients in terms of less post-operative complications, healing without scaring, functional benefits, positive patient perception and acceptance of the treatment. One hundred fit and healthy paediatric patients (aged 4-15 years) were recruited to undergo laser surgery for different soft tissue conditions. The outcome of these laser treatments was examined. The Wong-Baker Faces Pain Rating Scale was employed to evaluate the pain before, immediately after laser treatment in the clinic and 1 day after post-operatively at home. Post-operative complications and patients' perception and satisfaction were self-reported during a review telephone call the day after treatment. The patients were reviewed 2 weeks after surgery. Laser parameter was 1.62 W, measured by power meter, continuous wave mode with 50 % emission cycle. The beam spot size at the target tissue was 0.8 mm. The pain score pre-operative, during and immediately after laser treatment was rated 0. Whilst the pain score 1 day after surgery was rated between 0 and 2, the healing time was measured over 2 weeks. None of the patients reported post-operative complications after surgery. Patients' perception and acceptance were rated very good. Laser dentistry is a promising field in modern minimally invasive dentistry, which enables provision of better care for children and adolescents. In this cohort study, the use of the carbon dioxide laser therapy offers a desirable, acceptable and minimally invasive technique in the surgical management of soft tissues in paediatric oral surgery with minimal post-operative complications.

Developing a tool to preserve eye contact with patients undergoing colonoscopy for pain monitoring.

Colonoscopy has become the leading procedure for early detection and prevention of colorectal cancer. Patients' experience of colonic endoscopic procedures is scarcely reported, even though it is considered a major factor in colorectal cancer screening participation. Pain due to air inflation or stretching the colon with an endoscope is not rare during examination and may be the main obstacle to cooperation and participation in a screening program. We propose a four-stage study for developing a tool dedicated to pain monitoring during colonoscopy, as follows: (1) comparison of patient, nurse, and endoscopist questionnaire responses about patient pain and technical details of the procedure using the PAINAD tool during colonoscopy; (2) observation of the correlation between patients' facial expressions and other parameters (using the short PAINAD); (3) development of a device for continuous monitoring of the patient's facial expression during the procedure; (4) assessment of the usability of such a tool and its contribution to the outcomes of colonoscopy procedures. Early intervention by the staff performing the procedure, in reaction to alerts encoded by this tool, may prevent adverse events during the procedure.